一期后路小切口椎弓根钉内固定和前路病灶清除植骨治疗胸腰椎结核

One-stage posterior small incision approach pedicle internal fixation and anterior focus clearance and bone graft for treatment of the thoracolumbar tuberculosis

目的探讨一期后路小切口椎弓根钉内固定和前路病灶清除植骨治疗胸腰椎结核的临床效果。方法 2005年5月至2010年5月收治30例胸腰椎结核患者,其中胸椎结核6例,胸腰椎结核15例,腰椎结核9例。术前采用四联正规抗结核治疗2～4周,所有患者均采用后路小切口椎弓根螺钉系统矫形内固定,同期行前路病灶清除植骨术。术后继续抗结核治疗。结果随访11～54个月,平均28个月,所有患者椎间植骨均达到骨性愈合标准,腰背疼痛及神经症状均明显缓解,术后Cobb角平均为5.7°,随访1年平均为6.9°。结论一期后路小切口椎弓根钉内固定和前路病灶清除植骨术是一种创伤相对较小、骨融合率高的治疗胸腰椎结核的有效方法。

Objective To study the clinical effect of one - stage anterior focus clearance and bone graft and posterior small incision approach pedicle internal fixation for treatment of the thoracolumbar tuberculosis. Methods Thirty eases were treated surgically from May 2005 to May 2010, including 6 cases of thoracic tuberculosis, 15 cases of thoracolumbar tuberculosis, and 9 cases of lumbar tuberculosis, who were treated with routine antituberculous medication for 2 - 4 weeks pre - operatively, then one - stage minimally invasive posterior ap- proach pedicle internal fixation, and they underwent anterior focus clearance and bone graft, antituberculous medication used after operation. Results All patients were followed up for a period ranging from 11 months to 54 months, with an average of 28 months. Bony fusion was obtained in all patients. The back pain and neurological deficits showed obvious improvement in most patients. The average kyphosis Cobb＇s angle was 5.7°after operation, and which was 6.9° after one year follow up. Conclusion One - stage anterior focus clearance and bone graft and posterior small incision approach pedicle internal fixation is a method of minor trauma and high rate of bony fusion in treating thoracolumbar tuberculosis.